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Arthur John McLean - a student of Harvey Cushing, the father of American
neurosurgery and Otfried Foerster, the celebrated German neurosurgeon -
was Portland's first trained neurosurgeon. His life was cut short by a
tragic accident and so it is uncertain what his future might have held.
What emerges from the record is his recognized brilliance contrasted
against the intense drama of his life.

When Dr. McLean died on December 7, 1938, he was just 44 years old and had
not yet reached the apex of his career. When his body was found, the
wheels of his car hung over the edge of the canyon where it had crashed
through a guardrail on N.W. Cornell
Road. The car was still running; his body was some 10 feet from the car, a
handkerchief tied around a deep wound on his head.

Some alleged that McLean had committed suicide while others asserted that
McLean would not have taken his life. One Portland physician is quoted as
saying, "McLean simply wasn't the kind to kill himself. He was the sort
who would want to stick around, just to prove that all he had said was
right." (Oregonian, 2/5/1939). McLean had made enemies and had
denounced
his opponents fervently. He demanded perfection of himself and of others.
Another physician remembers, "...a charge of laxity was perhaps the
bitterest accusation that he hurled at his fellow physicians."
(Oregonian,
2/5/1939). Some said he had grown bitter and had developed deep
prejudices.

McLean was born in Seattle on October 29, 1894. A two-year stint in the
military interrupted his education at Reed College, from which he
graduated in 1921. The Griffin,
Reed's yearbook, described McLean as, "The busiest man on
campus... carrying
six subjects was his business..." He was ever the personification
of that
term "intellectual enthusiasm." He went on to receive his M.D. from Johns
Hopkins Medical School in
1925. He studied neurosurgery with Harvey Cushing, as a neurosurgical
resident at Peter
Bent Brigham Hospital (1925-1929). He was Surgical House Officer
(1925-1926), the Arthur Tracy Cabot Fellow, in charge of laboratory
research at Harvard Medical
School (1926-1927), Associate in Surgery, Peter Bent Brigham Hospital
(1928-1929), and Acting Resident in Surgery at Peter Bent Brigham Hospital
(June –September
1929). He then moved to Breslau, Germany with his wife, Gladys Merle
Bragg, where he studied from 1929-1930, as a George Gorham Peters
Traveling Fellow, with Dr. Otfried Foerster. He returned once again to
Boston in 1930-1931, to serve as a Resident in Surgery before moving to
Portland.

In 1931, McLean entered private practice in Portland, opening an office in
the Medical Arts Building. He joined the faculty of the University of
Oregon Medical School as clinical instructor in Surgery and
Neuropsychiatry (1931-1934), assistant professor of pathology (1936-1938)
and clinical associate in Surgery and Neuropsychiatry (1934-1937). In
1937, he resigned his position but at the behest of his colleagues he
returned, continuing as assistant professor of pathology until 1938, when
he once again resigned. He went on to teach, independently, a course for
clinicians in Neurological Diagnosis and Neurological Surgery at Good
Samaritan Hospital.

From the McLean collection, we know that he gave the impression of being
brash, disrespectful and hot-headed. But the record also portrays a man of
reason, who could not stand dishonesty and hated stupidity. His fellow
faculty members pronounced him a "brilliant" physician, his teaching work
"beautifully" organized, and that he was a "magnetic" person in the eyes
of the medical students.

McLean was invited to be one of the charter members of the Harvey Cushing
Society.
In the Founding book, there is a letter to McLean from William P. Van
Wagenen, dated October 24, 1931, inviting McLean to join as a founder.
McLean accepted and Van
Wagenen acknowledged his acceptance. Oddly, there is no record to explain
why he was never listed as a member. In addition, in the volume, A
History
of Neurosurgery, there is no reference to McLean. Further, it seems
that
he did not belong to the Society of Neurological Surgeons because he is
not listed among their historical figures.

He was accused by some of his detractors of writing nothing new, yet
others claimed that his findings were not mere mimicry but based on
indisputable and dedicated research. Dr. Cushing appeared to be always
supportive of his work: In 1936 Cushing writes to "Mac" and pronounces
McLean's paper on cerebral neuroepithelioma "…a perfectly bang-up piece of
work. We are delighted with it… it is certainly the best worked-up case in
the literature." Cushing encouraged him not to apologize for his youth.
Foerster was equally confident and affectionate. He invited him to
contribute to his Handbuch der Neurologie in 1936. McLean
authored two
chapters titled "Intracranial Tumors" and "Pituitary Tumors." The
prevalence of requests for reprints of his papers came from around the
world. McLean's operative record speaks well of his competence as a
neurosurgeon. His mortality rate in 55 operations over 6 years was 21.8%
and compared well with other leaders in his field. Cushing's mortality
rate in 11 years was 30.9% though in the final years dropped to 8.7%.

Two anecdotes surface from the collection, which illustrate McLean's
qualities that raised the ire and respect of adversaries, associates and
friends alike:

To commemorate Cushing's 60th birthday in April 1928, a
festschrift
was to
be published as a special volume of the Archives of Surgery.
McLean was
invited to contribute a paper. He submitted a manuscript titled, "A New
Type of Apparatus: Its Physics and Results", in which he gives a technical
description of the Bovie Electro-surgical Unit (surgical current
generator). In 1920 William T. Bovie had developed this innovative
electro-surgical unit that Cushing had introduced to clinical practice.

McLean submitted his manuscript for editing to G. H. Liebel (of the
Liebel-Flarsheim Company, manufacturers of the first Bovie), as well as to
Cushing, Bovie, and others.
Liebel's response to the paper was that it would be "way, way over the
head of any physician or surgeon and would be way, way over the head of
any engineers." Further, Dr. Liebel informed McLean that Bovie was about
to deliver an address
describing the electro-surgical unit.

Bovie's reaction to McLean's paper was scathing. Bovie wrote to McLean
discrediting his attempt to write about the biophysical aspects of
electro-surgery as "confusing froth...leading to no definite conclusion...
You are writing," Bovie charges, "in a field for which you have not been
adequately trained. Many of [your] ideas are erroneous… and might give you
a reputation of being superficial." Bovie went on to say that, McLean's
description of their invention before they (Bovie and Liebel) published
about their own work was equal to stealing. He also accused him of not
giving credit to others involved in the research. He threatened that if
McLean did not assure him that he and Liebel would have priority to
publish, he would take it up with Cushing.

McLean's rejoinder is equally acerbic: "Your extraordinarily harsh
letter, he begins, "...arrived this afternoon. I think my letter of
yesterday morning is sufficient personal answer to your gratuitous slurs
concerning publications in medical fields. The paper is recalled, and I
shall take care that I publish nothing whatever concerning the machine or
its use so long as you remain alive; I think that may be a reasonable
guarantee against even the possibility of inadvertent trespass upon the
field you have vigorously marked out." Since he had been forewarned of
Bovie's upcoming presentation, McLean immediately withdrew the manuscript.

Cushing wanted McLean's paper to be published, but the histological part
of the paper hinged on the apparatus. So rather than have nothing appear
from McLean, Cushing offered to furnish a general description of the
machine for anonymous inclusion in the paper, but McLean declined saying
it was overly general and vague therefore worthless.
He returned it to Cushing to be used in the Scott lecture where Bovie was
to give his address.

Liebel, in correspondence with McLean, writes, "I believe the one who is
going to suffer most from this [falling out] is Dr. Cushing." McLean
offered the photographs that were to be included in his article to the
Liebel Company but adamantly refused to be acknowledged for them.

Cushing once again requested that McLean submit the paper for publishing
and at this,
McLean acquiesced. In spite of the dissention, the paper was published in
the festschrift. In the end, McLean apologized profusely to Bovie
and the
two men eventually spent a great deal of time discussing the paper. Bovie
simply did not feel that McLean should address the technical description
of the machine in surgical literature. 1

McLean was not easily discouraged. In 1929, while still at Peter Bent
Brigham Hospital with Cushing, he had received a grant to research the
electro-surgical operating unit and to investigate and perfect a simpler
and more flexible unit. And even after the disagreement with Bovie, McLean
continued to write about electricity and surgery.
He published, "Characteristics of Adequate Electrosurgical Currents" in
the American
Journal of Surgery, December 1932. As well, physicians and scientists
continued to request reprints of his articles in the field of
electro-surgery and solicit his recommendations for electrosurgical
apparatus for cutting and coagulation.

A second anecdote of great local interest concerns his relationship with
his colleagues in Portland. As noted earlier, McLean repeatedly resigned
from the faculty. All that can be discerned from our records is that they
had intense disagreements over policies. However, the disagreements appear to have been extensive and McLean was
never one to mince words.

In November 1937, he delivered an 80-minute clinical report before the
Multnomah County Medical Society in which he lashed out at certain members of the
medical profession. He later had this address, titled "Brain Tumors Always
Die: A Satiric Parade", privately printed at his own expense. In this
diatribe he denounced, first of all, those who still believed that brain
tumors represented only a death sentence: "Among the enlightened places
where one would expect not to find doddering adages still extant are
hospitals. Yet the title of my paper, "Brain Tumors always die" is the
factual recording of a remark made pre-operatively on three
widely-separated occasions to different patients of mine by the sisters in
a Portland hospital. The first time it occurred I believed it was but a
repetition of the 1890 adage; the second time I wondered if that was the
sole reason and after the third, I took my patients elsewhere, believing
it useless to attempt cooperation for the patient's benefit in such
atmosphere."

He did not stop with the hospitals. "Neurosurgical work requires some 3 ½
-5 hours of examination for preliminary diagnosis; neurosurgical
operations demand for the patient's safety a fastidiousness of technique
often completely lacking at the hands of general abdominal surgeons not
specially trained in neurosurgical methods…. As a member of the
neurosurgical tribe, one has a right and a duty to demand of those who
profess to be its practitioners, a modicum of knowledge, of technique, and
of nicety which, by my observation of results, is quite absent in this
surgical slattern of whom I speak… The long list of resignations from the
surgical and clinical sides of the medical school since his
headship that
constitutes a role of honor; most of the men who are acknowledged leaders
in the specialties are locally found recently outside the medical school
rather than in it transmitting their knowledge to the younger men, and as
long as he remains in authority, with his tight ring of sycophants and his
interknit downtown clinical organization, so long will the clinical
teaching of surgery and surgical specialties at out local school remain
the chagrinned and amusing laughing-stock that it at present is for
students. As regards my own specialty, I have come to regard myself as
derelict unless I speak out in condemnation of such results as
representative of what modern neurosurgery can and does accomplish
whatever may have been the extenuation of the last decades, a continuation
in present circumstances has no warrant in fact or accomplishment."

In tribute to McLean it was said that "No one, anywhere, ever exemplified
a finer loyalty, a more loving nature, the kindliness of his contacts with
his students and those who wanted to learn from him was at times emotional
in its quality. No one will know, except those who were truly his
apostles, how much of himself he gave to teaching. In it he was consumed
not by an ideal of self-aggrandizement but by an unquenchable thirst for
the truth behind all the didacticism… Could McLean have achieved a
serenity of spirit to match the true greatness of so much of his
character, his intellectual and spiritual stature might have been
limitless. But he had very strong prejudices and feelings and had
developed a deep prejudice… Dr. Arthur McLean leaves accomplishments which
will dwarf the best of his detractors. In the proper setting, with more
wisdom and understanding on the part of his associates, he could, had he
conquered his small bitternesses, have become a world figure."3

According to his attorney, his affairs were in order down to the smallest
detail. His undated will was given national publicity: "To 95 percent of
Portland's medical practitioners and their ethics, and the whole local
organized medical profession, a lusty, rousing belch. To Portland's
thieving patients, the haphazard care they will receive for their
chiseling tawdriness. I desire that there be no funeral service of any
sort; that the eleventh stanza of Swinburn's 'Garden of Proserpine' and
the
entire 'Thanatopsis' of Bryant be read aloud over my body by a lay person;
that my cremated body's ashes be strewn by a paid employee on the waters
of the Straits of San Juan de Fuca.

And "To my name, oblivion" McLean declared in his last will and
testament. The unexamined records of A. J. McLean have lain silent for
nearly 70 years. There is little evidence to warrant censure or to condemn
his name to oblivion, yet up until this point in time it appears to have
been accomplished.

1 McLean's comments from the text
appearing in the Archives of Surgery,
April 1929, vol. 18 no. 4: The original manuscript was submitted for
criticism to a number of persons; among these was Dr. Bovie, who took
exception to the interpretation of some of the physical principles
involved. He had taken the trouble to write a description of the mode of
action of the currents employed, and, with his permission, his text, which
designedly avoids leaning on either resonance or quantum theories of
matter, is here substituted for the original.

2 Referring only to our records, it is unclear to whom "his headship" or
"this surgical slattern" refers. McLean notes in the address that another
neurosurgeon had joined the surgical staff: (It can be assumed that he was
referring to John Raaf.) "I have previously referred to the fact that,
with the entry of a second trained neurosurgeon into the local field, I no
longer feel that I can ethically be accused of thumping my own tub when I
speak of the state of neurosurgery as it actually exists in Portland, and
this is the sole purpose of my talk this evening."